Members of Congress often weigh in on FDA decisions to approve or reject new treatments for cancer and other life-threatening diseases, even when the science is weak. Pressure from policy makers to reduce spending on prescription drugs, moreover, is building support for more generic products, a trend that may shape the looming debate on "follow-on" biologics. This could have a direct effect on pharmaceutical and biotech manufacturers.

IGNORING STEM CELL SCIENCE Although the first embryonic stem cell was isolated in a US laboratory, future advances may occur elsewhere due to current administration policies. In August 2001, President Bush limited federal funding of embryonic stem cell research to already-established cell lines. Unfortunately, less than 20 of the 78 originally identified lines now appear to be available for research. To fill this widening gap, British officials have opened a national stem cell bank to store and distribute embryonic and adult stem cells to scientists around the world. And US states and research institutions are launching locally funded stem cell research initiatives.

NIH Director Elias Zerhouni responded to the House's letter with a carefully crafted statement that offered research advocates some hope for future change. Although Zerhouni reiterated the Bush administration's policy that public funds should not encourage destruction of human embryos that have potential for life, he also acknowledged that access to additional stem cell lines could speed scientific research. Zerhouni subsequently explained that the current policy is based on the president's moral and ethical concerns and admittedly not on scientific evidence. The hope is that the White House might open the door for researchers to access embryos abandoned in fertility clinics and slated for destruction anyway.

ENCOURAGING AIDS COMBOS On another front, the worldwide clamor for low-cost, fixed-dose combinations (FDCs) of antiviral drugs for third-world countries produced a positive response from Washington. At the opening of the recent World Health Organization annual meeting in Geneva, Health and Human Services Secretary Tommy Thompson announced a program promising speedy approval of already-marketed AIDS drugs that manufacturers will co-package in easy-to-use blister packs or reformulate as single pills.

To encourage manufacturers to submit applications for these products, FDA issued a draft guidance for industry on May 14 that spells out what sponsors must do to gain speedy approval (see http://www.fda.gov/cder/guidance/). The guidance lists drug regimens and components that FDA believes have sufficient clinical safety and efficacy data to support concomitant use and that fit agency criteria for two- and three-drug regimens. It notes that FDA has systems in place to handle priority review and fast-track designation of critical therapies. Plus, according to the guidance, FDA has the authority to refer to existing clinical safety and efficacy data, including published reports, to approve new combination drugs with little additional testing. FDA also expects to waive user fee payments and pediatric study requirements to speed these medicines to market. Manufacturers will need to propose systems for collecting and reporting adverse drug reactions in developing countries, an activity that local health agencies distributing the products are more likely to handle.